Validity and reliability of the Structured Clinical Interview for Mood Spectrum: Brazilian version (SCIMOODS-VB)

OBJECTIVE: The aim of this study was to translate the Structured Clinical Interview for Mood Spectrum into Brazilian Portuguese, measuring its reliability, validity, and defining scores for bipolar disorders. METHOD: Questionnaire was translated (into Brazilian Portuguese) and back-translated into English. Sample consisted of 47 subjects with bipolar disorder, 47 with major depressive disorder, 18 with schizophrenia and 22 controls. Inter-rater reliability was tested in 20 subjects with bipolar disorder and MDD. Internal consistency was measured using the Kuder Richardson formula. Forward stepwise discriminant analysis was performed. Scores were compared between groups; manic (M), depressive (D) and total (T) threshold scores were calculated through receiver operating characteristic (ROC) curves. RESULTS: Kuder Richardson coefficients were between 0.86 and 0.94. Intraclass correlation coefficient was 0.96 (CI 95 % 0.93-0.97). Subjects with bipolar disorder had higher M and T, and similar D scores, when compared to major depressive disorder (ANOVA, p < 0.001). The sub-domains that best discriminated unipolar and bipolar subjects were manic energy and manic mood. M had the best area under the curve (0.909), and values of M equal to or greater than 30 yielded 91.5% sensitivity and 74.5% specificity. CONCLUSION: Structured Clinical Interview for Mood Spectrum has good reliability and validity. Cut-off of 30 best differentiates subjects with bipolar disorder vs. unipolar depression. A cutoff score of 30 or higher in the mania sub-domain is appropriate to help make a distinction between subjects with bipolar disorder and those with unipolar depression.

O papel do polimorfismo funcional VNTR da região promotora do gene MAOA nos transtornos psiquiátricos

INTRODUÇÃO: Muitos estudos têm investigado a associação do polimorfismo VNTR (número variável de repetições em série) localizado na região promotora do gene da enzima monoamina oxidase A (MAOA) com alterações no comportamento humano e em diversos transtornos psiquiátricos. OBJETIVO: O objetivo do presente trabalho foi revisar a literatura sobre a participação desse polimorfismo funcional na modulação do comportamento humano para o desenvolvimento dos transtornos psiquiátricos. MÉTODO: A pesquisa foi realizada na literatura em inglês, de janeiro de 1998 a junho de 2009, disponível no Medline, Embase, Web of Science e na base de dados PsycInfo, utilizando os seguintes termos: "MAOA e comportamento humano" e "MAOA e psiquiatria". RESULTADOS: Foram encontrados 3.873 estudos. Desses, 109 foram selecionados e incluídos na revisão. Encontrou-se associação de alelos de baixa atividade do VNTR com transtorno de personalidade antissocial, transtorno de conduta, transtorno de déficit de atenção e hiperatividade, jogo patológico e dependência de substâncias. Alelos da alta atividade da MAOA foram associados a depressão, ansiedade, neuroticismo e anorexia nervosa. Não se encontrou associação entre polimorfismos da MAOA e esquizofrenia e transtorno bipolar. CONCLUSÃO: Os principais achados dão suporte ao papel do polimorfismo VNTR da região promotora do gene da MAOA em alguns transtornos psiquiátricos, apesar das divergências encontradas devidas às dificuldades metodológicas de estudos em genética. De modo geral, os estudos associam os alelos de baixa atividade da MAOA com comportamentos impulsivos e agressivos ("comportamentos hiperativos"), enquanto os alelos de alta atividade do gene são mais associados a "comportamentos hipoativos".

Eletroconvulsoterapia na terapêutica da mania em paciente com hidrocefalia

A evidência de segurança e eficácia do emprego de eletroconvulsoterapia (ECT) no tratamento de transtornos psiquiátricos em pacientes com distúrbios neurológicos é fundamentada, em geral, em relatos de casos. Em relação ao emprego em pacientes com hidrocefalia, há apenas oito casos descritos: seis abordando o tratamento de episódios depressivos, um para estado catatônico e um relato em paciente com auto-agressão. Os autores descrevem o caso de um paciente com 20 anos de idade, diagnóstico de hidrocefalia aos 12 anos, internado em ala psiquiátrica com episódio maníaco com sintomas psicóticos. Houve remissão completa da sintomatologia após quatro sessões de ECT. Não houve deterioração neurológica ou outros efeitos colaterais. O resultado sugere que a ECT é segura e eficaz no tratamento de episódios maníacos em pacientes com hidrocefalia.

Sinais neurológicos sutis: uma revisão

O objetivo deste trabalho é discutir o significado dos sinais neurológicos sutis e a relevância para a pesquisa em psiquiatria, com ênfase na esquizofrenia e no transtorno bipolar (TB). Realizou-se uma revisão da literatura nas bases de dados Medline e Bireme. Sinais neurológicos sutis são alterações no exame neurológico que compreendem funções diversas como integração sensorial, coordenação motora, sequenciamento motor e presença de reflexos primitivos. Esses sinais indicam disfunção cerebral não focal, podendo se apresentar como fatores de risco para transtornos psiquiátricos. Podem indicar endofenótipos relacionados a disfunções em circuitos neurais específicos, fornecendo informações relevantes para fisiopatologia desses transtornos. Apesar disso, há poucos trabalhos sobre o tema na literatura nacional. A observação de sinais neurológicos sutis aponta para o potencial de o exame neurológico preencher uma lacuna entre a pesquisa neurobiológica e a prática clínica.

Avaliação in vivo do metabolismo do córtex pré-frontal dorsolateral em pacientes bipolares em episódio maníaco : um estudo com espectroscopia por ressonância magnética

Introdução: Diversas anormalidades neuroquímicas têm sido relatadas no Transtorno Bipolar (TB), mas os verdadeiros mecanismos envolvidos na fisiopatologia do TB permanecem a ser elucidados. A técnica de espectroscopia por ressonância magnética (1H-MRS) permite a mensuração de certos neurometabólitos no cérebro humano in vivo. Nós utilizamos a 1H-MRS para investigar o N-acetil-L-aspartato (NAA), compostos de colina (Cho), creatina/fosfocreatina (Cr) e o myoinositol (Ino) no córtex pré-frontal dorsolateral (CPFDL) em indivíduos bipolares durante episódio maníaco/misto. Métodos: Dez pacientes bipolares (9 maníacos, 1 misto), diagnosticados através de uma entrevista clínica semi-estruturada (SCID), e 10 voluntários normais pareados por sexo e idade foram estudados. Os neurometabólitos foram mensurados através de voxels de 8cm3 localizados no CPFDL direito e esquerdo para aquisição da 1H-MRS de 1.5T. Imagens de ressonância magnética anatômica ponderadas em T1 e T2 foram obtidas para excluir quaisquer anormalidades neuroanatômicas. Resultados: Não foram encontradas diferenças significativas para NAA, Cho, Cr, Ino, NAA/Cr, Cho/Cr, ou Ino/Cr entre pacientes e controles. Pacientes maníacos/mistos apresentaram níveis significativamente aumentados de myoinositol no CPFDL esquerdo em relação ao CPFDL direito (p = 0,044). Conclusões: Elevação do myoinositol no CPFDL esquerdo em pacientes bipolares durante mania aguda pode representar uma disfunção na via de sinalização do fosfatidilinositol. Estudos longitudinais com maior amostra avaliando o pré e pós-tratamento são necessários para melhor esclarecer este tema.

Modelo animal para estudo do temperamento : relevância para os transtornos de humor

Temperamento é hereditário e relativamente estável no padrão de emoções básicas tais como medo e raiva. Nós exploramos traços de temperamento em camundongos para selecionar fenótipos distintos com extremos de temperamento. Em um ambiente novo (campo aberto) com objeto central, dois grupos de 15 animais a partir de 79 foram selecionados e separados de acordo com alta e baixa exploração do objeto para compor os grupos de alto e baixo exploradores, respectivamente. O desempenho destes animais foi idêntico no mesmo teste uma semana depois e se manteve distinto oito meses depois, sugerindo a presença de traços de temperamento. Estes camundongos foram posteriormente testados em outras tarefas comportamentais. Comparados aos baixo exploradores, os camundongos alto exploradores foram menos ansiosos no claro-escuro e no labirinto em cruz elevado, mostraram aumento na locomoção no campo aberto, apresentaram melhor desempenho no decorrer dos testes do Labirinto de Lashley (estímulo apetitivo) e tiveram alta latência para descer da plataforma no teste de esquiva inibitória (estímulo aversivo). Camundongos alto exploradores se mostraram agressivos no teste de intruso, enquanto que os baixo exploradores se mostraram passivos ou submissos. Estes resultados mostram que diferenças individuais no temperamento influenciam grande parte dos comportamentos em camundongos. Esse perfil comportamental dos camundongos alto e baixo exploradores se assemelha a temperamentos depressivos e hipertímicos de pacientes com depressão unipolar e bipolar.

Avaliação comportamental e neuroquímica de ratos em dessincronização forçada: possíveis implicações para um modelo animal de oscilações no humor

Bipolar disorder has been growing in several countries. It is a disease with high mortality and has been responsible by the social isolation of the patients. Bipolar patients have alterations in circadian timing system, showing a phase shift in various physiological variables. There are several arguments demonstrating alterations in circadian rhythms may be part of the bipolar disorder pathophysiology. Given the necessity for further elucidation, the goal of this study was to validate the forced desynchronization protocol as an animal model for bipolar disorder. To do this, Wistar rats were submitted to a forced desynchronization protocol which consists in a symmetrical light dark cycle with 22h. Under this protocol, rats dissociate the locomotor activity rhythm into two components: one synchronized to the light / dark cycle with 22h, and another component with period longer than 24 hours following the animal endogenous period. These rhythms with different periods sometimes there is coincidence, which we named CAP (Coincidence Active Phase) and the opposite phase, non-coincidence, called NCAP (Non-Concidence Active Phase). The hypothesis is that in CAP animals present a mania-like behavior and animals in NCAP depressive-like behavior. We found some evidence described in detail throughout this thesis. In sum, the animals under forced desynchronization protocol were more stressed, showed an increase in stereotypic behaviors such as grooming and reduction in other behaviors such as risk assessment and vertical exploration when compared to the control group. The CAP animals showed increased locomotor activity, especially during the dark phase when compared to controls (rats under T24) and less depressive behavior in the forced swim test. The animals in NCAP showed a higher anxiety in elevated plus maze, but they don t have ahnedonia. The animals under dissociation have more labeled 5HT1A cells at the amygdala area, which appoint that they have more amygdala inhibition. Taking these data together, we could partially validated the forced desynchronization protocol as an animal model for mood oscillations

Efeitos do tratamento com lítio na memória aversiva, comportamentos relacionados à ansiedade e depressão e na expressão de BDNF em ratos

Lithium (Li) is the first choice to treat bipolar disorder, a psychiatric illness characterized by mood oscillations between mania and depression. However, studies have demonstrated that this drug might influence mnemonic process due to its neuroprotector, antiapoptotic and neurogenic effects. The use of Li in the treatment of cognitive deficits caused by brain injury or neurodegenerative disorders have been widely studied, and this drug shows to be effective in preventing or even alleviating the memory impairment. The effects of Li on anxiety and depression are controversial and the relationship of the effects of lithium on memory, anxiety and depression remain unknown. In this context, this study aims to: evaluate the effects of acute and chronic administration of lithium carbonate in aversive memory and anxiety, simultaneously, using the plus maze discriminative avoidance task (PMDAT); test the antidepressant effect of the drug through the forced swimming test (FS) and analyze brainderived neurotrophic factor (BDNF) expression in structures related to memory and emotion. To evaluation of the acute effects, male Wistar rats were submitted to i.p. administration of lithium carbonate (50, 100 or 200 mg/kg) one hour before the training session (PMDAT) or lithium carbonate (50 or 100 mg/kg) one hour before the test session (FS). To evaluation of the chronic effects, the doses administered were 50 or 100 mg/kg or vehicle once a day for 21 days before the beginning of behavioral tasks (PMDAT and FS). Afterwards, the animals were euthanized and their brains removed and submitted to immunohistochemistry procedure to quantify BDNF. The animals that received acute treatment with 100 and 200 mg/kg of Li did not discriminated between the enclosed arms (aversive and non-aversive) in the training session of PMDAT, showing that these animal did not learned the task. This lack of discrimination was also observed in the test session, showing that the animals did not recall the aversive task. We also observed an increased exploration of the open arms of these same groups, indicating an anxiolytic effect. The same groups showed a reduction of locomotor activity, however, this effect does not seem to be related with the anxiolytic effect of the drug. Chronic treatment with Li did not promote alterations on learning or memory processes. Nevertheless, we observed a reduction of open arms exploration by animals treated with 50 mg/kg when compared to the other groups, showing an anxiogenic effect caused by this dose. This effect it is not related to locomotor alterations since there were no alterations in these parameters. Both acute and chronic treatment were ineffective in the FS. Chronic treatment with lithium was not able to modify BDNF expression in hippocampus, amygdala and pre-frontal cortex. These results suggest that acute administration of lithium promote impairments on learning in an aversive task, blocking the occurrence of memory consolidation and retrieval. The reduction of anxiety following acute treatment may have prevented the learning of the aversive task, as it has been found that optimum levels of anxiety are necessary for the occurrence of learning with emotional context. With continued, treatment the animals recover the ability to learn and recall the task. Indeed, they do not show differences in relation to control group, and the lack of alterations on BDNF expression corroborates this result. Possibly, the regimen of treatment used was not able to promote cognitive improvement. Li showed acute anxiolytic effect, however chronic administration 4 promoted the opposite effect. More studies are necessary to clarify the potential beneficial effect of Li on aversive memory

A atividade física na saúde mental: uma revisão de literatura

Ao longo da história, a doença mental passou por diversos períodos de críticas relações com a própria humanidade, exposta à vulnerabilidade dos mitos e pré-concepções que motivaram a perseguição e segregação daqueles seres humanos qualificados como “insanos”. No Brasil, as primeiras intervenções específicas de atendimento à doença mental só ocorreram a partir da segunda metade do século 19. Atualmente a doença mental representa um dos maiores gastos da rede do SUS (Sistema Único de Saúde) (Ministério da Saúde do Brasil, 1999). Nas últimas décadas, a fim de diminuir o tempo de internação e o gasto com medicamentos, um conjunto de iniciativas surgiu como forma de transformar a compreensão cultural e a relação da sociedade com as pessoas que apresentam transtornos mentais. Dentre as novas propostas humanizadoras de atendimento, a educação física e, particularmente, o exercício, vieram mostrar sua contribuição nessa área. Para Silva (1995), a atividade física acarreta uma complexa rede de reações bioenergéticas no organismo e essas acabam por melhorar o rendimento físico e mental dos pacientes nas atividades de vida diária. Tendo em vista a relevância da intervenção através da atividade física no campo da doença mental, o objetivo deste trabalho foi analisar resultados dos estudos que demonstraram os benefícios da atividade física para indivíduos com transtornos psiquiátricos, considerando os aspectos fisiológicos e emocionais dos mesmos, através de revisão da literatura científica. Para isso, foi feito um levantamento nas principais bases de dados através do cruzamento de palavras chaves, tais como “saúde mental e atividade física”, “doença mental e atividade física”, “esquizofrenia e atividade física”, “transtorno psiquiátrico e atividade física”, “transtorno bipolar e atividade física”. Os resultados dos estudos revelaram que a atividade física possui...

Stigma and higher rates of psychiatric re-hospitalization: Sao Paulo public mental health system

Objective: The aim of this study was to assess re-hospitalization rates of individuals with psychosis and bipolar disorder and to study determinants of readmission. Methods: Prospective observational study, conducted in Sao Paulo, Brazil. One hundred-sixty-nine individuals with bipolar and psychotic disorder in need of hospitalization in the public mental health system were followed for 12 months after discharge. Their families were contacted by telephone and interviews were conducted at 1, 2, 6 and 12 months post-discharge to evaluate readmission rates and factors related. Results: One-year re-hospitalization rate was of 42.6%. Physical restraint during hospital stay was a risk factor (OR = 5.4-10.5) for readmission in most models. Not attending consultations after discharge was related to the 12-month point readmission (OR = 8.5, 95% CI 2.3-31.2) and to the survival model (OR = 3.2, 95% CI 1.5-7.2). Number of previous admissions was a risk factor for the survival model (OR = 6.6-11.9). Family's agreement with permanent hospitalization of individuals with mental illness was the predictor associated to readmission in all models (OR = 3.5-10.9) and resulted in shorter survival time to readmission; those readmitted were stereotyped as dangerous and unhealthy. Conclusions: Family's stigma towards mental illness might contribute to the increase in readmission rates of their relatives with psychiatric disorders. More studies should be conducted to depict mechanisms by which stigma increases re-hospitalization rates.

Efeito de ligantes do receptor NOP no modelo animal de mania induzido por metilfenidato

Bipolar disorder is a chronic psychopathology that reaches from 1 to 4% of the world population. This mood disorder is characterized by cyclical mood changes, in which an individual alternates between states of depression and mania. Mania is described in the literature as an abnormal state of exacerbation of humor, in which the subject presents an expansive, euphoric behavior, but with increased irritability, psychomotor agitation and a feeling of invincibility, which will contribute to risks exposure. The treatment of this psychopathology is complex and it is not effective in all cases, and it evokes many side effects. In this respect, the system of Nociceptin/Orphanin FQ (N/OFQ) can be studied as a possible therapeutic target for the treatment of bipolar disorder, due to its modulatory role on monoaminergic systems and on mood. This study aims to investigate the effect of NOP receptor ligands in an animal model of mania induced by methylphenidate. To this aim, locomotor activity was assessed in an open field, in mice treated with methylphenidate (10 mg/kg, sc, 15 min). Valproate (300 mg / kg, ip, 30 min), standard treatment of mania, prevented methylphenidate-induced hyperlocomotion. The acute treatment with the antagonist of NOP receptor UFP-101 (1-10 nmol, icv, 5 min) per se did not affect the spontaneous locomotion of mice, but it was able of attenuating hyperlocomotion induced by methylphenidate. The acute treatment with N/OFQ (1 and 0.1 nmol, icv, 5 min) did not alter the distance moved, but when tested at a dose of 1 ηmol, N/OFQ slightly reduced methylphenidate-induced hiperlocomotion. In conclusion, the administration of UFP-101 and N/OFQ produced antimanic-like actions. Furthermore, these data suggest that the system of N/OFQ performs a complex modulation of voluntary movement, and consequently on dopaminergic neurotransmission.

Padronização de testes para avaliação do estado de mania e potencial anti-maníaco de um agonista do receptor NOP

Bipolar disorder is characterized by mood impairment, alternating between mania/hypomania and depression, and its exact pathophysiology is already unknown. The treatment of bipolar disorder is based on prevention of the manic and depressive episodes using mood stabilizers. Nociceptin/orfanin FQ (N/OFQ) is an endogenous heptadecapeptide which binds as an agonist to NOP receptor, which is a G-coupled inhibitory receptor. N/OFQ and its receptor modulate a lot of functions in the organism, including emotional processes. It is known that the plasmatic concentration of N/OFQ is altered in patients in both phases depressive and manic of bipolar disorder and it is assumed that this system has a role on the etiology of this disorder. Concerning mania, the animal models used in research tend to focus in an unique aspect of the manic behavior, as hyperactivity or agressivity. In the 60’s, the hole board test was proposed, and it consists of an apparatus with holes where a behavior known as head-dippings is measured. High levels of head-dippings are suggestive of neophilia, while low levels can be characteristic of an anxious-like behavior. As the increase of exploratory and goal-directed behavior are characteristics of manic behavior, this test could help in mania research. Thus, this work was organized in 3 steps and aims to: (1) investigate the induction of a manic-like state promoted by ouabain, a Na+/K+-ATPase inhibitor, in the mouse open field test; (2) set up the hole board as a test to measure manic-like behaviors; and (3) investigate the N/OFQ effects in prevention of this kind of behavior on hole board. Male Swiss mice were used in this study, and they take part of only one of the described steps. Depending on the step performed, mice received one or more of the following treatments: (1) ouabain 10-6 , 10-5 , 10-4 , 10-3 or 10-2 M, intracerebroventricular (icv); (2) sodium valproate 300 mg/kg, intraperitoneal (ip); (3) sodium valproate 400 mg/kg, ip; (4) diazepam 1 mg/kg, ip; (5) methylphenidate 10 mg/kg, ip; and (6) N/OFQ 0,1 or 1 nmol, icv. The results suggest that hole board can be used to evaluate a manic state, through analysis of different animal behaviors. However, it was not possible to standard the model of Na+ /K+ -ATPase dysfunction through ouabain administration in mice. Moreover, the data suggest that N/OFQ, at the doses tested, has not affected the methylphenidate-induced mania-like behavior. Taken together, the results point to a new approach of manic research, through the hole board using. However, more studies are necessary in order to verify the role of N/OFQ system on bipolar disorder.

Personalidade e sua relação com transtornos de ansiedade e de humor: Uma análise da produção científica brasileira na abordagem cognitivo-comportamental

Personality is one of the most controversial and intriguing theme in Psychology. In a general way, it could be understood as a set of rigid patters of feelings, thoughts, and behaviors from an individual. The aim of this investigation was describe how Brazilian researches in Psychology that use cognitive, behavioral, and cognitive-behavioral therapy referential have been approaching the subject Personality in their work. We also intended to determine the frequency of publications on Personality Disorders to compare this data with the bibliographical production on Anxiety and Mood Disorders. Moreover, we tried to describe how the Personality construct - and even Personality Disorders construct - has been addressed in the work on the Anxiety and Mood Disorders chosen for this review. The PePSIC Periódicos Eletrônicos em Psicologia - e SciELO.ORG - Scientific Electronic Library Online - databases were used for research. We investigated 53 journals, including two specific Cognitive Therapies and Behavioral-Cognitive Therapy (TCC) periodicals. Within each journal, we undertook a systematic survey on publications on the themes: Personality, Personality Disorder, Panic Disorder, Social Phobia, Obsessive-Compulsive Disorder (OCD), Generalized Anxiety Disorder, Major Depression, Dysthymia and Bipolar Disorder. A preliminary research has resulted in 218 articles. A second filter has obtained 81 articles in which we the focused on this review. There were found thirty-eight articles on Anxiety Disorders, twenty-five on Mood Disorders and eighteen on Personality Disorders. It was found that 90% of the papers on Anxiety Disorders make no reference to the term Personality or make it in a discrete way. This number rises to 96% to Personality Disorder group. Analyzing the specific journals on TCC we verified that 97% of the articles on Anxiety and Humor disorders do not cite the term Personality or cite but not explore it. This results point to the low rate of studies addressing the Personality and personality disturbs. Then, we can suggest that the difficulty on treating this Axis II disturbs has been worsened by lack of knowledge produced on the subject, either for lack of interest among researchers or because of the methodological obstacles found on this field.

Anamnese psiquiátrica

Consulta psiquiátrica com vistas a anamnese de paciente psiquiátrico diagnosticado, posteriormente, como portador de transtorno bipolar tipo 1.